Psychoanalysis

Main menu

A concise history of Liaison-Psychoanalysis

Photo above: Mar del Plata, Argentina

The theoretical foundations:

exploring the intersection Psychoanalysis/Medicine

Summary

A historic overview of the complex relationship between psychoanalysis and medicine is presented. After the anaclytic inception of analysis, as established by its creator, S. Freud, the endeavours of his pupil Felix Deutsch – who kept his medical practice alongside his analytic career – are discussed. Deutsch questioned himself (rather unsuccessfully) on the “mysterious leap from the mind to the body”, lacking perhaps an adequate conceptual framework for his inquiry. The curious figure of Georg Groddeck is mentioned, as the beginner of a dubious “psychosomatic medicine”, searching for imaginary conjunctions, rather than for the real disjunctions caused by the Symbolic.

The detailed attempts of Michael Balint, who lets the physicians themselves speak out this predicament, follow after a gap brought about by World War II.

A different Balint group experience, as conducted by the French psychoanalyst Ginette Raimbault, is also discussed.

Three essays on medical epistemology – Canguilhem’s, Foucault’s and Clavreul’s, are examined, as they give rise to a change in the conceptions on the subject. The background of Lacan’s Seminar, which took place at the same time these essays became known, is also mentioned.

Key words: Liaison-Consultation, Psychoanalysis, History of Medicine, History of Psychoanalysis, History of Liaison-Consultation.

The relationship between psychoanalysis and medicine is not a simple one. Historically, the origins of psychoanalysis refer to a failure of knowledge; in his quest for truth, Freud worked through this shortcoming to discover the Unconscious at the same time that he established its method of exploration. Fragments of the former knowledge – i.e. Medicine – were dragged over to the new discipline, modifying their meaning substantially (e.g. the terms: symptom, trauma, and many others do not mean the same in each of the two discourses). A review of such origins has been repeatedly proposed and attempted.

This movement can be found in Liaison proceedings, whenever these are considered from a psychoanalytic perspective. An analogy may be drawn with the axiom according to which every case of psychoanalysis re-issues the discovery of the Unconscious, including the necessary obstacles and stumbling blocks faced by Freud. Thus, Liaison-psychoanalysis also recalls the history of psychoanalysis, and its origins in the medical discourse.

The following is an attempt to explore this background, and to prevent these concepts and their sources, from sinking into oblivion.

II. The first attempts

Although Felix Deutsch’s first contributions go back to 1919, he was probably the first to propose a possible articulation of medicine and psychoanalysis. Even though in his works he asks himself about the mysterious leap from the mind to the body2, 3, 6, he adds that both terms – i.e., mind and body – are the extremes of a continuum. Ruling out discontinuity, he remains within a “descriptive” conception of the Unconscious, which is not the Freudian innovation. Indeed, in Freud’s “Metapsychology” 7, a different, discontinuous model is worked through, the “systematic” Unconscious, which is entirely different from all the preceding models. It is clear, however, that Freud contented himself with asking his followers to acknowledge the existence of the Unconscious, and did not require from them the full understanding of its logic.

Above: Felix Deutsch

Therefore, Deutsch considers that bodily dysfunction falls together with the disorder of the drive in one of its developmental stages (here, the concept of drive is misunderstood as similar or equal to an instinct), and the signifiers where this state of affairs can be grasped are nothing but its effects. This is a classical pre- (and post-) Freudian romantic conception.

Of course, clinical findings object to it. When Deutsch meets “Dora”, Freud’s former patient and object of a paradigmatic case history, 24 years after this treatment, he is ready to study in her the “mysterious leap”. Indeed, Dora complains to him about several bodily disorders. However, she is also able to “leap” backwards, after becoming aware that her new physician (Deutsch) has been her former analyst’s disciple: “…my familiarity with Freud’s works apparently brought about a very favorable transference situation”. This optimism will soon be shattered. Very cleverly, in her second consultation her disorders have become exclusively psychic! Deutsch concludes: “she was one of the most repulsive hysterics I’ve ever met.”

III. A seemingly turbulent revolution – with very conservative results and consequences

In May 1917, the “uncanny” Georg Groddeck enters the psychoanalytic scene. Deutsch and Ferenczi answered to Freud’s initial enthusiasm with an echo of skepticism. The newcomer emphatically displayed a hyperbole of the romantic conception of the Unconscious. It is of considerable interest to trace this misunderstanding through the Freud-Groddeck correspondence, as some ever-menacing pitfalls of analytic developments clearly appear in the letters. 8

Above: Georg Groddeck

For Groddeck, resistance and transference do not necessarily indicate a full grasp of the analytical discourse. He uses them rather as passwords in order to present his mystical conception: an omnipotent unconscious, where every difference is cancelled, most especially the soul-body distinction.

Likewise, the expression “the well-known bodily disorder”, when used by Groddeck, does not indicate clearly whether the starting principle is looking[2] or listening (roughly and altogether schematically, the former approach corresponds to medical discourse, the latter to the analytic discourse). Not surprisingly, as the Unconscious is supposed to be able to “create” the illness, the analyst, fighting against this dark force, is supposed to have equal healing power. Understandably, he isn’t at all concerned about the possibility of being accused of “thaumaturgy”.

Freud insisted on his “psychic dualism” in order to keep the difference as the cornerstone of the logic of the Unconscious, i.e. a logic of uncompleteness. In the correspondence, he advises Groddeck to resist the temptation to reduce all the differences in Nature in an attractive Unity.

However, Groddeck stubbornly asserts that sexuality has no opponent drive. Both guilt and castration complexes only represent undesirable deviations of an original force.

Freud, worried as he was about the potential appearance of new apostates, ceases to insist. He merely appeals to Aristotelian prudence: “Nature should be neither endowed with a soul nor radically deprived of a spirit… ” The controversy clearly shows that the bodily edge of the signifier – the missing link – can neither be easily grasped nor explained.

And so, Groddeck remains unshattered in his “monism”. The Unconscious represents to him an overwhelming creative force, a Wholeness. For example, a gout tophus, or a foot callus are but physical expressions of the unconscious intention “not to stumble on the stone of wrath or rejection”

In 1917, Freud finally acknowledges that Groddeck’s position regarding the physic/psychic question is not his. The body acts as an obstacle to their communication, a mystery unsolved. [3]

Freud charges Ferenczi with the task of reviewing Groddeck’s lengthy essay, “The Book of the Id”. The resulting comment may be considered symptomatic, if we only take a look at the abundant negative expresions: “We should not reject any of Groddeck’s assertions that might initially alarm us…There are no considerations whatsoever entitling us to rule out these facts…There is no theoretical reason to believe that such processes cannot actually happen… 9

Much of the aforementioned efforts – like those of Deutsch and Groddeck – have been preserved in the American developments of “psychosomatic medicine”. Even if this thought-current is not the object of this paper – as the following lines will show, we attempt to concentrate on the dehiscence, the separating issues, the drifting apart of medical discourse and psychoanalysis – a space could be made to mention such significant figures as Franz Alexander and Helen Flanders Dunbar. As well-known, both authors were co-founders of the related Journal, adequately named “Psychosomatic Medicine”.

Alexander’s 1 output, produced in relationship to the Chicago Institute of Psychoanalysis, strives to differentiate “psychosomatic symptoms” from conversion in hysteria [4]. However, his remaining developments not only seek to demonstrate the validity and scope of the former; they also represent an attempt to establish a “personality pattern” for each one of the pretended “psychosomatic illneses”. The procedure amounts to describe new universal categories, thus fully consistent with the medical order, but already wide apart from psychoanalytic methodology which can only remain singular and particular.[5]

Above: Franz Alexander

Dunbar’s 4, 5 self-acknowledged ideologic starting point is the so-called “holistic” principle: an axiomatic original “harmonic” state, which has been inncesessarily disturbed by illness – an unwelcome guest. Medicine’s efforts strive to find the way back to primeval bliss, and psychology is but one further weapon to complete Science’s armor against the foe. Psychoanalysis reduces itself to the study of “emotional factors”, whilst metapsychology is ignored. However, this rather naive theoretical background changes dramatically when one reads the verbatim interviews in Dunbar’s books. The patients are listened to with an attention and associations-eliciting attitude that is very rarely met with today. Indeed, this allows us to proceed to our further point quite accurately.

IV. An original, new starting point: back to the doctor’s discourse

Michael Balint, the analysand and disciple of Sandor Ferenczi, carried out a significant achievement, which we shall turn to as our next step in our effort to elucidate this discursive crossover.

Above: Michael Balint

In 1960 Balint publishes his book, “The doctor, his patient and the illness” 10, in which he details the building up and the dynamics of the procedure that carries his name henceforth: the “Balint-group”. We may focus on one of its characteristics, strictly related to Liaison-proceedings: the formulation of a demand.

At a first glance, the project may seem to point at a generalisation: ‘to establish a pharmacology of the physician considered himself as a drug: its dosage, risks, secondary effects…”

However, the results move in opposite direction and the singularity of the physicians and their patient’s are clearly attained in the description.

When the object of the exchange between the doctor and his patient ceases to be a pill, the “semblance” of the doctor occupies its place. But the whole structure of the social tie changes, as we will see, allowing subjectivity to step out of the background as a positive fact, and no longer as a residue to discard

(“Currently, medical thought fears to omit some physical disease when focusing on the potential psychological causes”.)

Several case histories are presented among the group by each one of the physicians, and Balint transcribes this movement with almost novelistic detail. Bodily suffering filters through the patients’ questioning, and the doctors become the recipients of their words. Balint is wise enough to omit any ‘psy’ jargon.

One of the functions proper to a Master is to give a name that provides symbolic support. (“Only after knowing the name of his disease and his diagnosis, does the patient demand certain therapy, i.e., he wants to know how to ease his ailment…”). A physician wishing to sustain himself in this position cannot remain on the mere visible surface of the suffering body; he needs, as Balint puts it: “a more comprehensive diagnosis” aiming at the “study of neurotic symptoms”.

But this simultaneously sets him in front of a condition for which he is not accurately prepared. False solutions are at hand: the “complicity in anonymity”, or calling several “consultant specialists” i.e. appointing another Master with which to conceal his own flight. If the doctor perpetuates “the teacher-pupil relationship”, the transference may come to a standstill.

Balint charges the group and himself with the task of considering the role of the general physician as a “psychotherapist” and the group virtually becomes a multi-personal supervision.

After discussing the “offer” of symptoms that the patient presents (i.e., the demand, from our perspective), terms burrowed from economics keep showing up: the dialogue between the physician and his patient is described as a “reciprocal credit company”, which of course amounts to the signifiers invested by each partner. As the analyst is involved in his patient’s unconscious production, the physician is likewise participant in the disease “offered” by his patient, when he “accepts” it, i.e., when he oganizes the suffering under a medical term, a known disease’s name.

Balint is very much aware of the difficult situation which arises, in the current physician’s practice, when no “organic” cause is found, and he admits to his patient “there is nothing wrong with you”, a phrase that hits the latter like an ill omen. He is also sensible to the fact that providing the doctor with a widened listening ability sets up new problems: for example, one of the group members feels that he has reached a “dead point”. In analysis we are used to consider this situation, (i.e. a demand to which no satisfying answer may be supplied from a Master in knowledge, as this must come from the Unconscious), as the beginning of… transference.

Is this the physician’s wish?[6] Although remarkably interested in psychoanalysis, the physicians who worked with Balint do neither abandon their medical practice nor obturate their patients’ subjectivity stuffing them with psychodrugs. Let us remember that in those times, psychoactive medicines were not as exaggeratedly promoted by multi-national enterprises as they are now. Reading the book in our days, who doesn’t long and yearn for an atmosphere less polluted by technology?

What is more, the commented results during the group follow-up show significant therapeutic success. We can suspect that these are a product of transference, in the sense that Freud’s first experiences bore the mark of the procedure’s novelty, in a surprising way.

But when a general practitioner has engaged a psychotherapeutic relationship with his patient, is it possible to return to medical practice and become a physician again? Touching or seeing the body is then again a part of the medical procedure, or does it become an obscene exposition?

The avoidance of psychoanalytic terminology leads Balint to shift now to expressions taken out of the religious context. As he calls it, the physician’s “apostolic role”, falls together with countertransference in its strict analytic meaning (the physician’s prejudices, theories, expectations regarding how his patient should act or react, all of which are obstacles to their exchange). However, the discoursive field he has chosen allows us to feel a sacred dimension, which resounds in the classic Hippocratic texts. Decades later, Lacan in his lecture on Psychoanalysis and Medicine mentioned the fact that this dimension is currently threatened with extinction.

Thus, Balint proposes a “typology” of physicians based on their different ways of receiving and managing the demand. [7] He acknowledges not only that the doctor could be, up to certain extent, a part in the cause of his patient’s complaint, but also that there may be something beyond the demand of recovery (“some patients are thankful when the doctor allows them to be ill”)

Finally, Balint portrays the myth of a primeval encounter when the disease is not yet “organized”. The doctor’s position has then a determinative action, as he may even influence the disease’s form of appearance.

V. A different psychoanalytic outlook

The Balint group experience changes significantly on the other side of the English Channel. The group of paediatricians hosted by Ginette Raimbault 13 exhibits a commitment to psychoanalysis that goes well beyond the already vivid interest of their English colleagues. The environment surrounding the group feature, at least, some influential texts on the epistemology of Medicine that will be discussed later on, the convulsive Parisian atmosphere of 1968, and the background provided by the teaching of Lacan. [8]

Above: Ginette Raimbault

Whilst Balint presented the case histories briefly, in the form of small vignettes inserted in the text, each member of the French group takes a whole chapter to discuss each case. Raimbault adds some comments at each chapter’s end. These physicians display a thorough commitment: they do not hesitate to provide associations with their own personal problems or identifications with their child patients, or with their parents. The political context sometimes plays a leading role: one of the paediatricians devotes several pages to impeach the educational and sanitary authorities. The potential inconvenience brought about by technical jargon, carefully avoided by the English, is by no means a problem for the French: the physicians are thoroughly familiar with the psychoanalytic language describing the relationship between the infans and the Other as the place of the Signifier.

Balint himself visited Paris and this group in some occasions, and suggested an apparently simple (but actually highly complex) program: to identify the child’s symptom as a function in his parents’ discourse[9]. Consequently, there is an absolute change in the type of assistance. All the cracks, the stumblings, the shortcomings in the family framework become evident; the parents’ insufficiencies come to light as well as the physicians’. The latter are honest and brave enough to reveal them.

Those who are familiar with the present role of Care Centers dealing with family violence and child abuse, will not be surprised to see the physicians reporting of situations that widely differ from the idyllic and traditional Madonne col bambino[10] images. By doing so, the physicians are able to recognize and acknowledge unconscious death wishes, not only in the parents they listen to, but also their own.

What role can psychoanalysis have in the training of the paediatricians, if they are to remove obstacles hidden in discourses, signifiers that have been erased even in previous generations, in order to work through the child’s symptoms? How to elicit the “small but necessary and significant modification” in the doctor that enables him to listen accurately?

Raimbault explains that she conducts the group in analogy with a psychoanalytic cure. An analyst differs in many ways from a teacher, even if he is taken as such: through transference, the trainees’ desire is investigated. We may deduct that many of them may have felt the urge to continue their self-investigation on a couch… However, it is clear that all of them wish to remain paediatricians (i.e. not to become analysts!). It becomes necessary to be well aware of the difference, to sustain a position. This is the idea conveyed by the closing sentences:

“What are pediatricians?

What should they know, or ignore, to avoid becoming –,

psychopolicemen,

psychoanalysts,

naive,

and remain paediatricians?”

VI. The sources of a new epistemology

In the Paris of the ’70ies, three seminal studies in medical epistemology are published. 14, 15, 16 Together with the weekly development of Lacan’s open Seminar (his lectures start in 1952) and the edition of his “Écrits”, these three books will have an overwhelming influence on most of the ensueing papers attempting to describe the relationship between psychoanalysis and medicine:

1. “The normal and the pathological”, by Georges Canguilhem. This is an enlarged edition of Canguilhem’s thesis of 1943, with an afterword considering Selye’s adaptation theory. An attempt to distinguish between the normal and normative abstractions – statistics or theories aiming at an unattainable regularity, as these do not allow any possibility of transgression (while any human field includes this possibility as the rule). This applies particularly when the “rule” is not anymore considered in its biological context, the Sein (to be), and becomes an ideal-to-reach, the Sollen (ought to be). A very interesting observation is that the physician’s outlook is based on the latter rather than on the former: “our world is always and continuously an image of values”. And there is an explicit objective of mastership: “medicine…struggles to rule over the environment and organize it according to its living values”;

Above: Georges Canguilhem

2. “The Birth of Clinical Medicine”, by Michel Foucault; one of the first experiences of an “archeological” method to distinguish parallels, analogies and isomorphisms, in order to establish the history of the categories of thought underlying the “scientific” production. In this book, Foucault focuses specifically on the medical discipline, whilst in subsequent works he will turn to the “History of madness during the classical period”, and then to to the general, abstract field of “Words and Things” or “The Archeology of Knowledge”.

Above: Michel Foucault

Foucault restricts his investigation to French texts on Medicine of the XVII and XVIII Centuries – despite his conscientious criticism on French “monoglotyc narcissism”. The period he documents has not yet established the methodological obligatoriness of a “causal or pathogenic agent”; indeed, in all further developments, this will be the widespread appearance of medical discourse alienation, to the point in which subjectivity will be excluded from this discourse altogether.

Through these texts, Foucault reviews the configurations that lie hidden below the classifications. A list of these might be useful to remember:

the “botanic” model of a temporal regularity, stability and constancy of the “species”;

the “chemical” model involving the combination of discreet elements;

the “experimental” model that demands empirical verifying;

the “pedagogical” model in which the classification is carried on at the same time it is taught to the disciples, thus creating a simultaneous transmission without any kind of residue.

This kind of inquiry has a “discursive surface”, and an aim of finding a localisation, i.e. to establish a distinct place for the cause of the acknowledged and observed abnormality. There are, of course, phenomena that do not remain confined within a spatial point (neuroses, fevers) but they are thought to be the exceptions that secure the general rule. Freud and Hughlings Jackson are mentioned once in the text, as XIX-XX. Century heirs to this “medical topology” and its philosophical framework.

As in any other discipline, when the context changes, some parameters or characteristics, which have remained in the background, come into light. Life acquires the metaphorical status of obscurity (as it conceals the visible causes), while Death carries the Lights that reveal the truth in the corpse’s anatomy. By a firm alliance with technical language and frequency statistics, the visual register is heightened to attain a position of sovereign supremacy, standing as a reference for any other type of sensibility. The tacit, encyclopaedic project is to rule out any discursive shortcoming. An occasional, isolated interest for a particular, singular case does not contradict in any way the old Aristotelic law, after which an individual is not taken into consideration by scientific discourse. This is a historic reference for the immediate and unrelenting, unbound development of statistics, that sets probability calculation as a satisfactory substitute for mathematical certainty. [11]

3. “The Medical Order”, by Jean Clavreul. The connection with Foucault’s and Canguilhem’s books is mentioned in this essay’s Prologue. Clavreul has produced a text to which most of the forthcoming clinical and theoretical work on Liaison-consultation will be highly indebted. Henceforth, many essays and papers accordingly underline the differences between medicine and psychoanalysis, rather than attempting to produce an “integration” of the two (indeed, it could be said that efforts to “unite” both discipline are deceptive and/or failed, to say the least). Clavreul severely warns that the attempt to venture a supposed “contribution” by psychoanalysis to Medicine immediately becomes a political choice. In fact he asserts that it is discourse, and not the “facts” (not even technological facts!) that organizes the Medical Order (this statement places Clavreul’s description on the antipodes of any empirical perspective). All those who are within its field – the doctors as well as the patients, nurses, etc. – become the Order’s subjects, regardless of the individual circumstances. There is, therefore, no “doctor-patient relationship”; it would be more adequate to consider a confrontation between the Medical Institution and illness as such. When Balint, for instance, says that the doctor prescribes himself as a drug, it should be understood that he does so as a mere representative of Medicine, or of Science, while simultaneously excluding anything that medical discourse considers irrelevant (this is what any discourse does, especially when it is a discourse saturated by a tendency to master[12]). Medical Order is the reverse of psychoanalysis; Clavreul takes this from Lacan’s theory of the Four Discourses, in which the Discourse of the Master and the Discourse of the Analyst exclude each other reciprocally. His project is very far away from Balint’s. The latter attempted to transmit the analytic experience to the physicians, in order to show them that listening to subjective issues does not exclude rationality. Clavreul, however, disregards any identification of the doctor with his patient as an imaginary residue, and only considers significant the patient’s identification with the doctor’s emblems of prestige. In his long exposition, he doesn’t spend more than a few lines allowing the physician to change temporarily his discoursive position (switching, for example, to the analytic position and back again to the Medical discourse, as the Balint group members did frequently). He does not cease to insist in designating the doctor as a mere agent that impersonates an unmerciful, rigid juridic-technocratic structure.

Above: Jean Clavreul

VII. A provisional conclusion

Therefore, if the physician is taken to be a mere subject – or, rather, a prisoner of the Order that determines him, he appears like a kind of tyrant. We meet here the menacing apparition of Knock 22, the awesome and uncanny main character of the theatre play by Jules Romains, which doubtlessly has cast his shadow on Clavreul’s essay.[13] By now it might have become clear that any “integrating tendency” linking medical observations to a supposed “psychological cause” does nothing else than blur all boundaries confusingly, exactly what Knock does in the play.

Above: Louis Jouvet as “Knock”

Even so, we may hope that there could be another, less deceptive position that the doctor can make his own – may we call it an “ecumenical”?[14]– allowing him to acknowledge the discursive differences, while simultaneously being able to shift from one to the other when necessary.[15]

Is this not our everyday doctor, whom we meet daily at the Hospital, who listens to his patients and knows more about them that what we suppose he does, who asks from us a Liaison-Consultation precisely on account of this solid knowledge?

VIII. Notes

[1] The following paper describes the evolution of some concepts that support the practice of Liaison-Psychoanalysis. The practice itself is therefore not considered: it also follows that the difference of Liaison Psychoanalysis with Liaison Psychiatry isn’t discussed either, both aspects being dealt with in other papers.

The reader – being probably acquainted with the term Liaison-psychiatry – might find the term unfamiliar; for a comprehensive exploration of its scope and practicalities, however, see 0

A brief sketch of the procedure: taking place within a General Hospital, it usually starts in an in-patient unit, whenever a patient’s subjectivity produces a difficulty in a medical procedure. The physician or specialist in charge demands the assistance of a staff psychoanalyst to remove the obstacle. Consequently, the Liaison-consultant interviews the demanding physician, the patient (and others involved: the patient’s family, nurses, social workers, etc.) and continues to work through the situation until the aim is reached.

[2] Foucault’s and Lacan’s concept “le regard” has been translated in English as “the gaze”

[3] Whenever Freud finds limits to his analytic work, especially in the borders between psychical and organic suffering (e.g. the case of a lady with multiple sclerosis, depicted in the Correspondence we are discussing) he doesn’t hesitate to refer the patient to Groddeck, thus putting the latter’s phenomenal therapeutic appeal to the test.

[4] Strangely enough for a catalogue aiming to achieve the so called “a-theoricism”, even if the greek term has been dropped in the current DSM IV system, Freud and Breuers’ invention has been kept. Indeed, “conversion” only makes sense within the psychoanalytic theory.

[5] Justified critics on the vagueness regarding the results are abundant.

[6] Paul Lemoine used this expression in a lecture at the École Freudienne de Paris, modelling it after Lacan’s term, “the desire of the analyst”. During the following discussion, Lacan suggested that the extended use of an expression he has coined exclusively for the psychoanalyst might not be appropiate. See 11

[7] For another, similar attempt, see 12

[8] See also Raimbault’s second volume 17 with one chapter analysing the medical institution, and five case histories.

Before examining her attempt, however, some comments should be made on a significant case history, i.e. that of “Iiro”, the first in the series presented by Donald W. Winnicott 15. To no doubt, it fulfils every methodological aspect of a Liaison-consultation. The analyst visits a Finnish Hospital where he is asked to examine a 9-year old inpatient that had been admitted for surgery. He had to undergo several operations to improve, albeit if partially, his syndactily condition. The surgical act was hindered (besides unsignificant somatic or psychical disorders, such as “messing, headaches, abdominal pains”) on account of the patient’s excessive compliance. The case is deeply moving; we cannot discuss it here, but it may suffice to say that Winnicott performs all the steps of the Liaison consultive sequence: he interviews the doctors, the patient and his mother, the social workers, other staff members. He doesn’t skip any of the institutional environment’s links, and consequently produces remarkable therapeutic effects on each of them. Indeed, the chapter might be perfectly suitable as an Introduction to psychoanalytic Liaison procedures in a paediatric Hospital.

See also 16

[9] There are no available sources to study Balint’s relationship with French psychoanalysis, so the issue – besides the fact that Balint’s death left the question unsettled – might be regarded as conjectural. His intervention in the described group, as stated above, had a thorough efficacity. However, one might ask whether language and cultural differences acted as a hindrance, as in the case of Winnicott and Françoise Dolto.

[10] italian: Our Lady with the Child

Fra Angelico: Madonna col Bambino, Pinacoteca Sabauda, Torino, Italy

[11] Foucault continued his developments on “medicalization” and the “incorporation of the hospital to modern technology” in further books or lectures; see 20.

Lacan and Foucault were acquainted, and the former invited the latter to deliver lectures on special issues at his Seminar. However, the scope of each thinker regarding discourse is clearly different. Foucault thoroughly used linguistic references to establish his “archaeology” of thought categories in his first books, to concentrate himself immediately afterwards on the study of the use of discourse as a vehicle of power. Lacan tried to focus the structure of discourse itself (the result being the “theory of the four discourses”), but not from a linguistic point of view, as his endeavor and its validity remain linked to the psychoanalytic experience.

[12] Lewis Carroll has made the best description of this state of affairs in the dialogue between Alice and the Egg:

“’The question is,’ said Alice, ‘whether you can make words mean so many different things’

[13] Knock is a (fake) doctor who takes over the consultation-room of a country colleague who has left it. Up to this moment, the latter seldom or never had any work, as all the neighbors were strong as oaks. Knock finds this picture disastrous, as his motto is “Every healthy person is a sick individual ignoring his condition”. He doesn’t have to wait long, the following week his waiting room is overcrowded. The whole countryside has been subject to the Medical Order.

[15]In this context the work of Pierre Benoit should be mentioned. Like Felix Deutsch before him, Benoit develops both clinical medicine and psychoanalysis independently. For the task of linking these practices, he might be considered better endowed in his conceptual framework than his predecessor. See 23